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AVELLA OF DEER VALLEY, INC. #38
CH090850 AMPLA HEALTH
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Covered Entity Details
Entity Name
AMPLA HEALTH
Subdivision Name
Ampla Health Lindhurst Medical, Dental, & Xpress Care
Type
HRSA-Funded Health Center
340B ID
CH090850
Entity Address
4941 Olivehurst Ave
Olivehurst, CA 95961-4225
Grant Number
H80CS00765
Participating Start Date
1/1/1998
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
AVELLA OF DEER VALLEY, INC. #38
Pharmacy Address
DBA AVELLA SPECIALTY PHARMACY
24416 N. 19TH AVE
PHOENIX, AZ 85085
Pharmacy Comments
Contract Details
Approval Date
4/18/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/6/2017
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Cindy Anne Snelgrove, Chief Clinical Services Officer
(530) 751-3755
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
4/18/2017
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